Association of family history of bipolar disorder with risk of violence in inpatient mania: a cohort study

Abstract

Background Evidence suggests that a positive family history of bipolar affective disorder is associated with response to lithium and the course of the illness, in people suffering from this disorder. This may indicate a subgroup of patients with unique characteristics and treatment responses. Aims To explore associations between a positive family history of bipolar disorder and the risk of violence, in patients hospitalized for treatment of mania. Methods Adults receiving inpatient treatment for a manic relapse of bipolar affective disorder, at two tertiary care hospitals in Kandy, Sri Lanka were studied as a cohort. For each participant with a positive family history of bipolar disorder, an age and gender matched adult, also suffering from a manic relapse of bipolar affective disorder but without a family history, was included as a control. A second researcher, who was blind to the participants’ family history, assessed the risk of violence among all participants, at baseline, and at weekly intervals thereafter until discharge, using the historical clinical risk management Scale 20 (HCR-20). Results A total of 148 participants were included, with 74 each in the study arm and control arm respectively. Of all participants, 57% were females. Significantly higher rates of unemployment, harmful use of alcohol and absence of confiding relationships were found in participants with a positive family history; they also had a significantly higher mean average HCR-20 scores compared to controls. Conclusion A positive family history of bipolar affective disorder was associated with a higher risk of violence during hospitalization for a manic relapse, as indicated by the mean average HCR-20 scores. A positive family history may be a potential identifier of those at a higher risk of violence in bipolar mania.